Medicare opens doors to more data

Organizations to use info for public reports

If payer claims data creates a more robust picture of the cost and quality of care provided, then more data is better. But until recently, organizations that want to make use of data were doing without anything much from the Centers for Medicare & Medicaid Services. Seven organizations have received word from CMS that they’re getting their hands on data this spring from Medicare outpatient and pharmacy claims.

Data junkies aren’t usually irrationally exuberant, but the people at Oregon Health Care Quality Corporation (Q Corp) are extremely happy to have wider access to Medicare claims data, says Katrina Kahl, MPH, director of communications for the organization.

“Having data from another part of the continuum is really important,” she says. “Hospitals increasingly need to know what is happening in primary care.”

Q Corp has had some Medicare Advantage data available, as well as Medicaid and private insurer data. But Kahl says that with care coordination so vital and a huge emphasis on preventing readmissions, getting some patient-level detail on what is happening on the outpatient front can only assist hospitals that are trying to get a glimpse at something more than their little patch of real estate.

The data should be with the organization in the summer, when it will be added to an existing claims database. It will be part of the regular twice-yearly reporting season for 20 primary care data points. Kahl is not sure if the data will be ready for the November data release for providers, which is delivered through a secure portal. But by the April release, the additional data will be part of the reports. The state report and consumer report, which come out in the new year, will also include the additional data.

Kahl says that Q Corp has applied for a grant that would allow for some cost of care reporting outside of its regular reporting cycles, too. “We could use the new data in other ways that we haven’t thought of or identified yet, too,” she adds.

For the time being, this data can allow users to see who is getting preventive care, who is showing up in the emergency department, and who is getting regular health screenings. That kind of information will be vital in the future when hospitals and other health care organizations try to parse out exactly who is at risk of readmissions or other adverse events and who isn’t.

“Having this Medicare fee-for-service data will give us another snapshot of what is happening,” she says. “We have a lot of initiatives in our state for data and metrics. Having access to more data, complete data, in a timely way to see how you as a provider or hospitals are doing is important.”

For more information on this story contact Katrina Kahl, MPH, Director of Communications, Oregon Health Care Quality Corporation, Portland, OR. Telephone: (503) 972-0865.